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Longer Symptom Duration Is Associated With Worse Absolute Outcomes but Similar MCID Achievement After ACDF
Mitchell Ng1, Gregorio Baek, Yulia Lee
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107.
Study Design:
Retrospective cohort study.
Objective:
To compare clinical outcomes and patient-reported outcome measures between patients with preoperative symptoms greater than or less than 12 months undergoing primary anterior cervical discectomy and fusion (ACDF) for the indication of radiculopathy.
Summary Of Background Data:
While ACDF is a well-established treatment for cervical radiculopathy, the impact of preoperative duration of symptoms (DOS) on postoperative recovery remains unclear. Prior lumbar and myelopathy studies suggest longer DOS correlates with poorer outcomes, but data regarding isolated cervical radiculopathy remains inconclusive.
Methods:
Adult patients undergoing elective primary ACDF for radiculopathy between 2014 and 2020 were identified. Patients with incomplete preoperative or 1-year postoperative PROMs were excluded. Patient demographics, preoperative nonoperative treatment, surgical characteristics, and clinical outcomes were collected from patient charts. PROMs, including SF-12, VAS Neck/Arm, mJOA, and NDI, were assessed preoperatively and at 3, 6, and 12 months postoperatively. MCID achievement was determined using pre-established thresholds. Patients were divided into two cohorts: DOS <1 year and DOS >1 year.
Results:
Of 170 patients, 107 (62.9%) had symptoms <1 year, and 63 (37.1%) had symptoms >1 year. Cohorts were comparable at baseline. The DOS >1 year cohort had a greater proportion of patients who received preoperative epidural steroid injections (58.7% vs. 41.1%, P=0.039). Postoperatively, there were no significant differences in rates of inpatient complications, including dysphagia, LOS, readmissions, or reoperations. While the <1-year cohort achieved higher absolute scores in MCS, PCS, and mJOA at 12 months, the rates of achieving MCID for all PROMS were comparable between groups.
Conclusion:
Although patients with shorter symptom duration may reach higher absolute PROM scores at one year, both groups experienced similar rates of clinical improvement and MCID achievement. A delay in surgical intervention for isolated radiculopathy may not adversely affect the patient's perceived benefit of the procedure.